This blog is totally independent, unpaid and has only three major objectives.
The first is to inform readers of news and happenings in the e-Health domain, both here in Australia and world-wide.
The second is to provide commentary on e-Health in Australia and to foster improvement where I can.
The third is to encourage discussion of the matters raised in the blog so hopefully readers can get a balanced view of what is really happening and what successes are being achieved.

7 comments:

Health is stuck in limbo-land. NEHTA came and went - no progress, just an expensive, useless IT system with no clinical benefits. ADHA has risen out of its ashes with the same mind set and the same people driving it.

Same old same old.

Australian health care, which isn't bad by world standards, will continue on regardless but opportunities will be missed and the government will waste even more money.

Sussan Ley may as well stay where she is, achieving nothing, mouthing platitudes, and not understanding what could have been achieved with real leadership and vision.

IMHO, if progress in eHealth is made in Australia, it will be in spite of the Federal government, not because of it.

ADHA has risen from the ashes with the same mindset and people driving it. So very true, and so very sad, even sadder when you think those behind the Royal report which sparked this, are shaping ADHA but setting the future up to fail and are in-fact making a mockery of the Royal report recommendations, oh sure they might tick a few boxes but ultimately their weakness in retaining senior staff and their minions will allow the rot to re-establish itself.

How right you are Bernard. If progress in eHealth is (to be) made in Australia, it will be in spite of the Federal government, not because of it. The only hope lies with industry finding a way to circumvent the extraordinary ineptitude and stupidity of the bureaucrats in charge. If that doesn’t happen the status quo will prevail for there are no other options.

Reluctantly I too have to agree with all 3 of you and in particular that "there are no other options". But in doing so I ask why are there no other options?

I think it's because the bureaucrats in charge to whom you refer stopped listening to industry and doctors a very long time ago. They became entrenched in their self-belief systems that they knew best and no-one could tell them otherwise, and those doctors and others who attempted to do so were branded as trouble makers and to be pushed to one side, like Murkesh and others. That includes aushealthIT commentators, peak bodies, privacy foundation, consumer groups.

The end result is that the bureaucrats became greatly empowered, and by association arrogant, by the enormous amount of money they had at their disposal to solve very difficult ehealth problems by continuing to promote an ill-conceived system which has become politically too embarrassing to curtail, or to accept the need to push the system back onto the drawing board for a complete rethink. If I'm wrong so be it, but I don't think so. If I'm wrong perhaps someone will be honest enough to tell me.

Colleagues I would like to take up the question: Why are there no other options?

There is another option. It is one that can and already has demonstrated its value.

However, it is this fundamental question of why other options are not being considered that merits our attention.

I suggest we start with the following propositions:

1. The current model is anchored in the Information Economy paradigm of the Internet and Web. In this case the PCEHR represents the website to which all are directed. (It certainly is not the Knowledge Economy model--for those into such distinctions.)

2. The current model was adopted in Australia very early on because it was the chosen model around the world; banking, telecommunications, media, travel, all these sectors were making great strides and it was OBVIOUS that health would also gain. The proponents of this design didn't bother to seriously ask the strategic Likelihood question: What is the Likelihood that the knowledge and assumptions that underpin this strategy are correct? We have been paying a heavy price for this arrogance.

3. The PCEHR was a Commonwealth Health initiative and therefore was backed by its financial and other resources. The States and Territories have simply agreed to cooperate while getting on with their own plans and activities. They actually know what it means to deliver care and be held to account for the failings of the health system.

4. The PECHR offers the Commonwealth the potential to gain access to large amounts of personal clinical data that can be of use directly and in combination with other federal data holdings (under the aegis of the MyGov website) for the purposes of identifying policy and regulatory actions to reduce the drain on government coffers.

5. The Department of Health--at least until the creation of the Australian Digital Health Agency--did not have a way out of the mess that has been created absent the Minister doing a David Cameron; that is, admitting that the initiative was a crock and cancelling it.

6. With the creation of the ADHA and the sequestering of the PCEHR therein the door is ajar for a New Idea.

7. This New Idea has to be brought to Health, probably on the grounds that Health represents a strategic opportunity to gain from this New Idea. This way, Health can do its own due diligence before commending it to others AND then working on a Transition Strategy.

8. The challenge is to find a 'channel' through which to address the strategic question that has been raised: Why are no other options being considered?

In all of this we should remember that the truth of an idea is not a stagnant property inherent in it. Truth happens to an idea. It becomes true, is made true by events. As long as people accept each other’s truths, they are passed on from one person to another without question.

Truth lives…for the most part on a credit system. Our thoughts and beliefs ‘pass’ so long as nothing challenges them, just as bank-notes pass so long as nobody refuses them. It’s only when something materializes, a new discovery, event or circumstance happens to break the spell of ‘truth’ that the public may begin to discredit one truth and move on to the next.

I think the problem is one of large government and the loss of any functioning market. In a way the west is now like the soviet union was. We had efficient structures but as we no longer allow failure the structures continue past their use by date and efficiency continues to fall, but we just whitewash everything to get to the next election. There is a book titled "Why success is built on failure" and its about stopping doing things that don't work any more.

Healthconnect, Nehta 1 and 2 didn't work and neither will "the agency" but failure is not an option, its "too big to fail" This doesn't mean it will succeed but the appearance of success will be maintained at any cost. In the end the west needs a crisis to get us out of this mode and its unlikely to be pretty when it comes, just like it came to the soviet union.

I don't think any amount of logical argument will have any effect. What has to happen is a crisis, which is unfortunate. Stock up on pitchforks is my advice ;-)

They said "During the 1990s, many industries—most notably, telecommunications, securities trading, and retail and general merchandising—invested heavily in IT."

And then promptly applied the same savings to health care coming up with a prediction:

"The adoption of interoperable EMR systems could produce efficiency and safety savings of $142–$371 billion."

This paper has been used to justify many other claims for benefits from health IT, probably even the PCEHR. Even if that paper itself hasn't bee used, the same simplistic thinking has.

Health care, especially decision making, is not like these other industries. They can automate simple, repeatable processes based upon sensor derived and accurate data.

Health data is not static, it is not certain and most data is not derived from simple sensors - there is a human interpretation phase. It is also highly context and environmentally sensitive and should be treated as such.

The simplistic approach of automating manual health record keeping was the first and most important error.

Recognising that error and then starting again is the only real option.

It reminds me of the quote attributed to Henry Ford:“If I had asked people what they wanted, they would have said faster horses.”

Ask your average GP what they want and they'll probably answer: "more data".

IMHO, that's the wrong objective. What they need is more appropriate data, which is a whole different ball game and is a much harder thing to deal with because it does not lend itself to automating simple procedures or conducting simple, isolated, independent tests.

The only other option is to think differently about the problem, otherwise the resulting solution will be just the same.